Credit Application

Complete the form below to begin the credit approval process. Our team will review your application and respond within two business days.

Application for Credit & Rental Agreement

In order to process your request, this agreement must be electronically signed at the bottom of the form.

Customer

Customer Name (Individual or Company) *

Street Address

City

State

Zip

Phone Number *

Business Information

Entity Type *

corporationLLCpartnershipproprietorship

Previous Business Name

State Entity Formed

Business Phone

Federal Tax ID#

D & B #

Driver's License (optional — last 4 stored)

Have you ever filed bankruptcy?

If Partnership or LLC, list partners / members

Signatory (Authorized Agent)

Name *

Title / Relationship

Address

Phone Number

Email Address *

A copy of the submitted application will be emailed here.

Banking Information

Bank Name

Contact Name

Address

Account Number (last 4 stored)

Bank Transit / Routing

Accounting Information

Job #s RequiredTax Exempt (attach proper form)

Insurance Company

Insurance Contact Person

Insurance Phone

Certificate of Insurance being forwarded

An insurance certificate is required prior to rental.

Accounts Payable (A/P) Contact

A/P Email Address

A/P Phone Number

Trade References

Signature Confirmation

By submitting this application online, I confirm the accuracy of all information above and authorize SEEK Equipment Rentals to verify the information and conduct a credit evaluation.

I confirm the information above is true and accurate (electronic signature).

Applicant Signature — Typed Full Name *

Date *

All information provided is kept confidential and used solely for credit evaluation purposes. A copy of your completed application will be emailed to the signatory address you provide.